Owner's Name
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First Name
Last Name
Dog's Name
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Email
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What issues are you most concerned about?
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When did this behavior start?
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Please check off any of the following that coincided with the change in your dog's behavior
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If other, please briefly explain
Please provide a general description of the issue including as much information as you can
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What (if anything) has been done so far to address this issue
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If steps have been taken to address the issue, did your dog's behavior improve, worsen, or stay the same?
If your dog has threatened or bitten another dog, please check all that apply
If other, please explain
If your dog has threatened or bitten a person, please check all that apply
If other, please explain
For each specific incident, please provide the following information (Date, Location, Who was present? Were other dogs and animals present? Was your go on a leash? What caused the incident? Had your dog been feeling well prior to the incident? Did your dog give any warning signals?)
Incident #1
If there was a dog bite, what location of the body?
Did it cause bruising?
Was there bleeding?
Was there a puncture wound?
Were their multiple puncture wounds?
did the dog bite, latch on, and shake their head from side to side?
Ho was the incident finally resolved?
Please breifly explain what the next 30-60 seconds were like after the fight was over and both animals were under control?
If their was a bite was their medical help sought?
If there was a bite, was it reported?
If their was a bite was their legal action taken?
Which of the following best describes your feelings about your dogs behavioral issues?
Is there anything else at all you feel we should know?
